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EPRINT   AND    CIRCULAR  SERIES 


NATIONAL  RESEARCH 
COUNCIL 


THE  STAfi 


.INI-  )LOGY 


By  F.  L.  WELLS 


CHIEF   OF   PSYCHOLOGICAL   LABORATORY,   BOSTON 
PSYCHOPATHIC  HOSPF 


L 


Published  in  Mc.ital  II 


[Reprinted  from  MENTAL  HYGIENE,  Vol.  VI,  No.  1,  January,  1922,  pp.  11-22.] 


THE  STATUS  OF  "CLINICAL"  PSYCHOLOGY 

F.  L.  WELLS,  PH.D. 
Chief  of  Psychological  Laboratory,  Boston  Psychopathic  Hospital 

HE  problems  of  civilized  human  adjustment  have  long 
since  divided  themselves  up  among  certain  systems. 
Medicine  has  looked  after  man's  body.  Law  has  looked  after 
his  social  relationships.  Religion  has  assumed  the  care  of 
his  otherworldly  relationships.  The  present  discussion  con- 
cerns psychology  as  a  factor  in  these  various  disciplines, 
with  special  reference  to  medicine. 

The  lack  of  coordination  between  medicine  and  psychology, 
in  their  application  to  the  guidance  of  conduct,  arises  from 
the  development  of  types  of  work,  of  a  psychological  nature, 
that  have  an  appropriate  place  in  the  management  of  certain 
clinical  and  social  groups  of  cases.  This  work  is  little  covered 
in  medical  training,  or,  save  exceptionally,  by  medical  men. 
It  is  being  covered  more  and  less  well  by  persons  more  and 
less  competent  in  psychology  or  its  techniques.  With  the 
ambition  to  be  of  service  goes  responsibility  for  adequate 
performance  of  that  service.  There  is  a  growing  sentiment 
that  if  psychology  is  to  take  its  proper  share  in  the  guidance 
of  human  adaptations,  there  must  be  a  more  responsible 
organization  of  its  work  for  this  purpose. 

Under  the  auspices  of  the  National  Research  Council,  there 
was  held  at  Washington,  in  the  spring  of  1921,  a  conference 
of  representatives  of  psychiatry  and  psychology,  to  discuss 
the  difficulties  of  the  situation  and  to  promote  a  better  under- 
standing of  the  respective  points  of  view.1  The  purpose  of 
this  paper  is  to  review  some  of  the  nuclear  remarks  made  on 
this  occasion,  with  particular  reference  to  the  medical  point 

1  The  following  associations  took  part  in  the  conference:  American  Associa- 
tion for  the  Study  of  the  Feebleminded ;  American  Medico-Psychological  Associa- 
tion; American  Neurological  Association;  American  Psychological  Association; 
American  Psychological  Association,  Clinical  Section ;  American  Psychopatho- 
logical  Association;  National  Committee  for  Mental  Hygiene;  National  Research 
Council;  National  Research  Council,  Division  of  Medical  Sciences;  New  York 
State  Association  of  Consulting  Psychologists;  Southern  Society  for  Psychology. 

1 


2  THE  STATUS  OF  "CLINICAL"  PSYCHOLOGY 

of  view  and  its  indications  for  action  on  the  part  of  psycho- 
logical organizations. 

It  is  easy  to  agree  that  medicine  and  psychology  should 
cooperate  for  the  public  good,  etc.  The  essential  issue  is 
raised  in  asking  whether  such  cooperation  is  to  be  secured 
through  a  new  professional  class,  the  psychologists,  or  through 
an  infiltration  of  psychology  into  the  medical  curriculum. 
Forecast  is  made  of  a  person  "with  biological,  educational, 
social,  psychological,  and  medical  background;  he  need  not 
have  the  various  types  of  training  in  obstetrics,  surgery,  and 
the  other  varied  fields  of  the  conventional  medical  course."1 
Such  a  person  should  work  as  a  highly  qualified  expert  in 
the  field  of  mental  adjustments. 

To  a  program  like  this  medicine  would  accede  provided  the 
training  were  given  in  a  medical  school,  with  enough  of 
general  medicine  to  justify  the  medical  degree,  and  with  the 
assumption  of  medical  responsibilities.  In  thinking  of  back- 
ground, one  should  perhaps  guard  against  overloading  the 
informational  side  of  such  a  program.  Most  of  the  informa- 
tional detail  to  be  insisted  on  is  of  a  medical  character.  There 
is  certain  information  that  must  be  available  before  any 
maladjustment  case  is  handled  with  ordinary  safety,  and  this 
information  is  not  to  be  had  save  through  medical  training. 
As  medicine  sees  it,  the  specialist  postulated  will  have  to  be 
a  physician. 

There  is,  however,  a  group  of  "clinical"  psychologists 
large  enough  and  coherent  enough  for  the  development  of  a 
definite  esprit  de  corps.  Certain  conditions  affecting  a  pro- 
fessional class  of  this  kind  should  not  be  lost  sight  of.  It 
belongs  with  the  law  and  with  medicine  in  dealing  with  human 
adjustments,  as  against  engineering,  for  example,  which  deals 
with  material  things.  The  practitioners  of  law  and  medicine 
are  in  great  part  supported  by  individuals  who  seek  pro- 
fessional help — from  the  doctor  when  they  are  feeling  sick, 
from  the  lawyer  when  they  are  feeling  wronged.  The  value 
of  a  profession  for  private  practice  upon  human  beings  de- 
pends essentially  on  what  it  can  do  to  get  people  out  of 
trouble.  If  psychology  is  to  develop  further  as  an  accom- 

l  Harry  L.   Hollingworth,   PH.D. 


plishment  of  private  practice  in  this  sense,  it  must  be  able 
to  take  care  of  a  certain  class  of  individual  troubles  better 
than  the  lawyer  or  the  physician  can  take  care  of  them.  Before 
predicating  the  development  of  a  professional  class  of  con- 
sulting psychologists,  one  must  consider  carefully  how  great 
is  the  class  of  troubles  that  psychology  is  distinctively  quali- 
fied to  meet.  They  are  not  unallied  to  the  type  of  difficulties 
that  now  go  to  the  religious  confessor  or  to  systems  of  healing 
that  have  a  quasi-religious  basis.  There  are  grave  difficulties 
in  the  way  of  meeting  this  type  of  troubles  with  the  setting 
of  scientific  psychology  that  is  now  available.  This  is  not  out 
of  harmony  with  the  fact  that  individuals  of  good  personality 
and  exceptional  insight  have  been  able  to  make  of  themselves 
a  Vaterersatz  in  the  psychoanalytic  sense,  to  guide  less  stable 
personalities  among  life's  pitfalls,  and  earn  material  reward 
therefor,  all  in  the  name  of  scientific  psychology.  Such  things 
are  done  in  the  name  of  medicine  or  law  also,  not  to  mention 
systems  of  far  less  standing.  It  is  on  these  individual  grounds 
that  the  few  conspicuous  successes  in  private  work  that  psy- 
chology records  seem  best  understood.  They  are  not  pro- 
tagonists of  a  professional  class  of  the  same  standing  that 
they,  as  individuals,  represent.  A  professional  class  of  a 
less  pretentious  order,  the  expert  in  mental  measurement,  or 
psychometrist,  is  already  a  part  of  the  educational,  and  to 
some  extent  the  psychiatric,  system.  Medical  education  here 
seems  of  rather  less  relevance  than  in  the  case  of  the  dental 
practitioner.  Few  psychologists,  however,  would  see  in  this 
development  a  solution  of  the  problem,  or  consider  that  it 
adequately  represented  the  contribution  of  psychology  to 
medical  or  educational  science. 

On  the  medical  side,  an  approach  to  the  adjustment  already 
suggested  is  made  through  a  three-year  graduate  medical 
course,  at  the  end  of  which  "one  might  be  more  or  less 
authoritatively  designated  as  a  psychiatrist  or  neuropsychia- 
trist".1  With  such  training  one  should  come  as  close  as  is 
practicable  to  the  ideal  of  the  "psychobiologist".  In  con- 
sidering the  substance  of  psychology's  contribution  to  such  a 
course,  it  should  not  be  forgotten  that  practical,  if  not  psy- 

IHugh  T.  Patrick,  M.D. 


4  THE  STATUS  OF  "CLINICAL"  PSYCHOLOGY 

chologically  systematic,  study  of  human  behavior  pervades 
the  whole  atmosphere  of  medical  training  to  an  extent 
approached  in  no  other  discipline  save  perhaps  the  law. 

The  program  suggested  in  the  above  paragraph  is  clarified 
by  a  proposal  for  "the  development  of  medical  education 
along  the  lines  of  extending  the  responsibilities  and  corre- 
spondingly the  educational  and  practical  equipment  of  the 
physician.  .  .  .  The  physiologist  would  have  been  compelled 
to  undertake  certain  practical  work  for  mankind  had  not 
medicine  adopted  physiology  ...  as  a  basic  science.  Now 
if  the  medical  profession  is  prepared  to  take  over  psychology 
.  .  .  either  as  an  independent  science  or  as  an  extension  of 
physiology,  it  seems  that  we  have  one  possible  solution  of  our 
present  practical  difficulty. ' n 

In  view  of  such  considerations,  it  is  not  surprising  to  find 
argument  from  the  side  of  psychology  for  the  introduction  of 
psychobiology  into  medical  education  as  a  basic  science.  It 
is  said  of  psychology  and  psychiatry  that  "one  is  very 
obviously  a  branch  of  science,  the  other  a  particular  applica- 
tion of  scientific  knowledge.  "2  The  term  psychology  is  like 
chemistry  in  denoting  both  pure  and  applied  science,  but 
psychology  has  in  psychiatry  a  term  whose  etymology  denotes 
application.  Actually,  also,  "clinical"  psychology  is  non- 
medical  psychiatry.3  So  soon  as  psychology,  the  science,  is 
applied  to  human  difficulties,  it  falls  within  the  definition  of 
psychiatry.  The  present  teaching  of  psychiatry  involves  not 
a  little  teaching  of  psychology,  whose  fragmentary  character 
is  somewhat  offset  by  its  concreteness.  The  suggestion  is 
offered  that  a  saving  of  time  when  it  is  of  particular  value 
would  be  effected  if  the  student  had  a  carefully  designed 
course  in  psychology  early  in  the  curriculum,  or  pre-medic- 
ally. 

The  nearest  alternative  to  the  gradual  incorporation  of  the 
medical  phases  of  psychology  into  medical  education  is  for 
"the  psychologist  to  continue  his  present  efforts  to  establish 
definite  standards  for  psychological  work,  to  lay  down  high 

1  Robert  M.  Yerkes,  PH.D. 

2  Robert  M.  Yerkes,  PH.D. 

3  A   psychologist  has  recently   been  appointed  psychiatrist  to  the   Bureau   of 
Public  Welfare  in  one  of  the  Southern  states. 


THE  STATUS  OF  "CLINICAL"  PSYCHOLOGY  5 

definitions  of  what  it  is  to  be  a  psychologist,  and  to  get  these 
on  record.  ...  On  the  other  hand,  psychiatry  must  continue 
to  educate  the  medical  profession  to  look  upon  itself  as  a 
distinct  specialty  dealing  with  mental  disease  in  a  strict 
sense."1 

The  first  of  these  proposals  may  and  should  be  carried  out 
irrespective  of  other  developments.  It  happens  that  the 
medical  phase  of  psychology  where  standards  can  be  most 
objectively  formulated  is  in  the  field  of  psychometrics.  It 
should  be  a  matter  for  official  concern  that  the  popular  or 
medical  conception  of  "psychologist"  does  not  come  to  rep- 
resent something  confined  to  the  psychometric  level.  While 
"high  definitions"  must  be  less  objective,  these  considerations 
make  them  probably  as  urgent.  Any  standards  now  prac- 
ticable should  be  formulated  with  the  expectation  of  making 
them  progressively  more  exacting.  Ultimately  they  should 
embody  medical  requirements. 

The  physician's  disposition  to  concede  the  second  point 
does  not  appear.  It  is  contended  that  "the  whole  progress 
of  clinical  medicine  is  toward  dealing  with  minor  and  rela- 
tively insignificant  departures  from  health,  where  there  is 
opportunity  for  prevention  and  early  treatment."2  Con- 
templation of  the  number  and  type  of  problems  referred  to 
psychiatry  in  out-patient  services,  or  in  contact  with  school 
systems,  offers  little  prospect  that  this  extension  of  medical 
activities  will  be  limited  by  developments  within  psychology. 

The  imponderabilia  of  medical  discipline  receive  from  the 
conference  not  more  than  their  due  weight.  No  class  that 
does  not  pass  through  a  comparable  discipline  should  expect 
to  enter  into  the  privileged  relationship  of  the  physician 
toward  his  patient  or  the  attorney  toward  his  client.  The 
old  saying  that  one  should  always  tell  the  whole  truth  to  one 's 
doctor,  one's  lawyer,  and  oneself,  expresses  the  almost  equal 
privileges  of  the  two  relationships.  "The  doctor  has  devel- 
oped, during  his  medical  course  and  hospital  interneship  and. 
practice,  a  protective  and  responsible  relationship  towards 
sick  persons  that  no  other  profession  has.  ...  Tn  every 
civilized  country  women  and  children  are  entrusted  in  the 

1  Harry  L.   Hollingworth,   PH.D. 

2  Thomas  W.  Salmon,  M.D. 


6  THE  STATUS  OF  "CLINICAL"  PSYCHOLOGY 

most  confidential  relations  to  physicians  with  hardly  any 
casualties/'1  In  the  varied  and  scattered  training,  sometimes 
one  of  sophistication  rather  than  of  experience,  that  now  con- 
notes the  psychologist,  there  is  nothing  comparable  to  this 
medical  training. 

There  is  a  rather  strong  feeling  among  medical  men,  not 
unshared  in  psychology,  that  the  discipline  of  medical  train- 
ing is  a  proper  prerequisite  to  certain  types  of  psychological 
research.  These  are  exemplified  as  * '  the  mental  aspects  of  the 
sex  life  in  children,  people  who  are  feebleminded,  diseased, 
prevented  from  exercising  a  normal  choice  as  to  the  extent 
of  the  investigation  or  the  method."  It  is  largely  felt  that 
matters  thus  touching  on  intimate  and  emotionally  charged 
topics  should  be  studied  by  medical  men  or  under  medical 
direction.  Interest  in  such  studies  is  by  no  means  a  criterion 
of  qualification  for  them — it  may  be  quite  the  reverse.  Their 
significance  as  a  sexual  Partialtrieb,  the  rationalization  for 
them  derivable  from  psychoanalysis,  with  the  easy  abuse  of 
laboratory  license,  make  it  important  in  medical  eyes  that 
such  avenues  of  research  should  be  carefully  guarded.  That 
the  discipline  of  the  medical  course  does  contribute  to  a  more 
objective  attitude  toward  such  topics  is  hardly  to  be  ques- 
tioned. Stress  is  also  laid  on  the  responsible  nature  of  the 
physician's  relationship,  now  far  from  established  in  the 
case  of  the  psychologist. 

It  is  thought  that  these  points  are  often  passed  over  too 
casually.  "The  training  of  the  medical  man  is  not  merely 
the  question  of  giving  him  a  certain  amount  of  information 
...  he  is  brought  into  very  special  and  somewhat  privileged 
relation  with  sick  people  in  regard  to  very  vital  issues.  .  .  . 
This  training  enables  the  physician  to  put  aside  a  great  num- 
ber of  conventional  prejudices  and  personal  feelings."8 

It  is  argued,  and  again  with  reason,  that  "medical  training 
does  not  include  the  whole  range  of  human  behavior,  nor 
does  it  concern  itself  with  all  problems  of  adaptation.  There 
appear  to  be  problems  that  have  a  wider  significance  than 
those  which  the  medical  training  so  far  offered  has  enabled 

l  Thomas  W.  Salmon,  M.D. 
3  Thomas  W.  Salmon,  M.D. 
3  C.  Macfie  Campbell,  M.D. 


THE  STATUS  OF  "CLINICAL"  PSYCHOLOGY  7 

one  to  handle  well."  This  returns  to  the  vital  part  of  the 
issue.  Granted  that  there  is  such  a  lack  in  medical  training, 
is  it  to  be  supplied  through  psychology  or  through  psycholo- 
gists? Is  the  question  that  of  a  professional  class  seeking 
to  establish  a  standing  as  such,  or  is  the  contention  for  the 
place  of  a  certain  discipline  in  that  system  of  training  which 
is  historically  responsible  for  the  organism's  well-being? 

Medicine  should  not  be  expected  to  look  with  favor  upon 
the  management  of  an  ailment  independently  of  medical 
authority.  It  is  said  that  some  people  will  go  to  a  psycholo- 
gist before  they  will  to  a  physician,  nor  can  the  psychologist, 
without  sacrifice  of  the  patient's  interest,  at  once  send  them 
to  a  physician.  The  physician  replies  that  such  cases  are 
insignificant  in  number.  It  must  not  be  lost  sight  of  that 
very  similar  considerations  would  apply  to  persons  who  have 
first  recourse  to  various  systems  of  faith  healing.  The  point 
is  made  that  one  does  not  fulfill  one's  duty  to  the  patient 
without  the  best  practicable  control  of  objective  factors  with 
which  the  physician  alone  is  trained  to  deal.  Recognition  of 
this  is  not  lacking  in  psychological  quarters.  "There  would 
be  no  hesitation  on  the  part  of  all  psychologists  to  feel  that 
medical  examination  was  desirable  and  essential,  even  if  the 
findings  were  negative.  .  .  .  The  question  of  sequence  will 
arise.  Which  examination  is  to  precede  the  other!"2 

To  some  extent  this  question  answers  itself  in  terms  of  the 
type  of  examination  to  which  the  individual  first  comes.  As 
to  synthesis,  undoubtedly  there  are  cases  in  which  psychology 
provides  a  better  synthesis  than  does  medicine  in  its  ordinary 
sense.  Also,  there  are  psychologists  who  can  synthesize  such 
cases  better  than  the  average  physician.  The  best  equipment 
for  synthesis  now  available  seems  to  be  a  genius  for  certain 
aspects  of  psychology  plus  a  medical  education. 

A  physician  states  the  ethics  of  the  situation  to  the  effect 
that  "in  the  community  where  there  is  a  well-trained  body  of 
medical  men  who  have  spent  years  in  studying  these  disorders, 
it  would  be  the  natural  thing,  the  desirable  thing,  for  the 
psychologist  to  refer  these  cases  to  these  individuals.  In  a 
community  where  such  people  are  not  available,  then  it  might 

1  David  Mitchell,  PH.D. 

2  Francis  N.  Maxfield,  PH.D. 


8  THE  STATUS  OF  "CLINICAL"  PSYCHOLOGY 

be  proper  for  the  psychologist  to  deal  with  the  cases  in  the 
light  of  his  special  training.  The  psychiatrist  living  in  other 
communities  would  not  resent  this.  One  would  like  to  have 
in  every  community  the  possibility  of  the  individual  getting 
help  of  a  rather  advanced  nature."1 

Attention  is  directed  to  complications  that  may  arise  in 
the  cross-reference  between  psychologist  and  physician. 
"Suppose  the  patient  originally  goes  to  the  psychologist,  who 
refers  him  to  a  physician,  who  finds  him  physically  all  right. 
.  .  .  There  is  no  assurance  that  the  patient  will  remain  that 
sort  of  patient.  The  question  of  diagnosis  cannot  be  disposed 
of  once  and  for  all.  ...  If  the  psychologist  is  not  familiar 
with  psychoses,  he  is  not  in  a  position  to  decide  either  at  the 
beginning  or  at  any  other  stage  when  the  individual  needs 
medical  help."2 

It  will  probably  be  approved  by  all  physicians,  and  by  many 
psychologists,  "that  the  terms  'clinic'  and  especially  'clin- 
ical' be  eliminated  from  the  psychologist's  technical  vocabu- 
lary. The  introduction  of  these  terms  has,  to  be  sure,  been 
innocent  enough,  but  it  now  proves  to  have  been  unfortunate. 
Clinical  psychology  as  it  exists  to-day  is  something  entirely 
different."3  The  most  forcible  objection  is  the  implication  of 
a  medical  setting  where  none  exists.  The  clinical  psychologist 
also  finds  a  large  part  of  his  work  in  educational  rather  than 
in  pathological  fields.  As  indicative  of  something  the  psy- 
chologist does  not  do,  and  not  indicative  of  what  he  does, 
there  is  no  term  whose  tabu  at  the  hands  of  the  psychologist 
is  more  advisable.  A  prominent  medical  school  lists  a  course 
in  "clinical  physiology".  In  such  a  setting,  it  is  not  impos- 
sible for  clinical  psychology,  as  that  portion  of  clinical  prac- 
tice concerned  with  the  mental  processes  of  the  patient,  to 
find  a  more  descriptive  application. 

However  extensive  its  boundaries,  it  is  surely  clear  that  the 
explored  territory  of  psychology  and  the  degree  of  organiza- 
tion within  it  do  not  constitute  it  a  discipline  coordinate  to 
medicine  or  law  or  religion.  Psychology  is  one  of  those 
sciences  that  have  particularly  to  do  with  human  health 

1C.    Macfie    Campbell,    M.D. 

2  Hugh  T.  Patrick,  M.D. 

3  Communication  from  Robert  8.  Woodworth,  PH.D. 


THE  STATUS  OF  "CLINICAL"  PSYCHOLOGY  9 

through  human  adjustment.  The  other  sciences  of  this  char- 
acter have  developed  naturally  as  medical  sciences.  Dis- 
tinguished names  attest  that  the  early  days  of  psychology 
did  not  lack  points  of  contact  with  medicine.  Overlapping 
has  been  more  recent. 

Neither  anatomy  nor  pathology  nor  physiology  nor  psy- 
chology is  so  constituted  as  to  carry  the  whole  weight  of  a 
human-adjustment  problem.  Psychology  is  the  latest  of  these 
to  bring  forward  knowledge  of  particular  value  in  such  prob- 
lems. As  such,  it  has  a  similar,  but  not  greater,  place  as  an 
autonomous  profession  than  belongs  to  other  medical  sciences 
or  to  different  branches  of  the  law.  All  of  psychology,  indeed, 
is  not  a  medical  science,  any  more  than  is  all  of  chemistry, 
from  which  medicine  takes  over  its  biological  aspect.  The  * '  men- 
tal age"  of  psychology  is  that  of  chemistry  fifty  years  ago,  yet 
to  take  over  psychology  might  be  a  larger  order  than  could 
profitably  be  disposed  of.  If  medicine  does  attempt  to  take 
over  psychology,  it  is  right  to  ask  the  taking  over  of  not  less 
than  is  relevant  to  medical  problems  in  the  broad  sense  in 
which  medicine  now  conceives  them.  In  one  field  of  psy- 
chology— namely,  psychoanalysis — principles  and  methods 
were  both  developed  by  physicians.1  To  this  should  be  added 
the  simpler,  but  more  objective  field  of  psychometrics,  while 
granting  that  much  routine  work  in  this  field  requires  no 
more  psychological  than  medical  background.  Psychometrics 
should  be  covered  up  to  the  point  where  the  cases  in  hand 
cease  to  be  medical  problems,  wherever  this  line  be  drawn. 
The  general  course  in  psychology  should  be  based  on  genetic 
study  of  the  personality,  giving  more  attention  to  affective 
and  instinctive  life  than  does  psychometrics,  but  having  a  more 
objective  foundation  than  psychoanalysis.  If  medicine  is  to 
dominate  the  field  of  human-adjustment  problems,  it  should 
incorporate  as  much  of  psychology,  as  of  other  science,  as  is 
relevant  thereto.  This  seems  to  be  the  best  solution  both  for 
medicine  and  for  psychology.  Should  one  expect  the  standing 
of  non-medical  psychologists  to  be  unfavorably  affected  by 
such  a  development?  While  medical  education  will  un- 

i  It  cannot  be  too  clearly  realized  that  psychoanalysis  is  not  a  medical  applica- 
tion of  principles  discovered  by  others,  but  grows  out  of  principles  and  methods 
developed  for  strictly  medical  purposes  by  men  with  that  type  of  training. 


10          THE  STATUS  OF  "CLINICAL"  PSYCHOLOGY 

doubtedly  become  a  more  and  more  frequent  and  advantageous 
part  of  the  consulting  psychologist's  equipment,  this  need  not 
prejudice  the  standing  of  the  consulting  psychologist  with  com- 
petence already  established  on  grounds  of  research,  teaching, 
and  personality.  Persons  being  trained  to-day  in  psychology 
have  an  advantage  over  their  fellows  of  twenty  years  ago  not 
incomparable  with  the  advantage  that  medical  education 
offers  to  the  psychologists  of  the  future.  How  seriously  has 
this  affected  the  standing  of  those  who  made  this  better  train- 
ing possible  ? 

The  psychology  of  to-day  is  a  species  of  myriapod  with  feet 
in  the  camps  not  only  of  medicine,  but  of  religion,  law,  educa- 
tion, sociology,  and  industry.  In  these  relationships  it  occu- 
pies a  distinctive  position  and  one  with  unusual  possibilities. 
As  Peter  the  Great  labored  in  foreign  shipyards  for  the  ad- 
vancement of  his  undeveloped  country,  psychology  should  not 
hesitate  to  incorporate  itself  with  better  organized  disciplines, 
in  which  its  own  progress  is  the  sole  limit  to  its  influence,  and 
some  of  which  it  may  in  time  come  to  dominate.  Law  and 
education  have  perhaps  not  fewer  natural  affiliations  with 
psychology  than  has  medicine,  but  these  disciplines  are  less 
markedly  under  scientific  influence,  and  there  is  in  them  no 
hierarchy  of  sciences  capable  of  assimilating  the  subject 
matter  of  psychology. 

It  is  hardly  to  be  claimed  that  one  can  acquire  sound  train- 
ing in  medicine  and  psychology  within  the  space  of  four  years. 
A  graduate  course  in  psychiatry,  such  as  that  before  men- 
tioned, would  have  to  carry  the  greater  part  of  such  psychol- 
ogical training  as  was  given.  This  would  be  that  part  of 
psychology  which  could  be  made  a  graduate  medical  subject, 
assuming  certain  fundamentals  pre-medically  and  in  the 
medical  course. 

The  American  Psychological  Association  recently  conducted 
an  inquiry  as  to  what  psychological  subjects  were  considered 
of  greatest  importance  from  the  standpoint  of  faulty  mental 
adjustments.  A  composite  of  ratings  by  81  persons  profes- 
sionally concerned  with  this  class  of  work  rated  various  course 
titles  as  follows,  a  maximum  score  for  practical  purposes 
being  486 : 


THE  STATUS  OP  "CLINICAL"  PSYCHOLOGY 


11 


Mental  measurement  (first  year) .  483 

Exceptional  children 482 

Techniques  applied  psychology. . .  463 

Mental  diseases 432 

Mental  measurement  (second 

year) 427 

Educational  psychology  (first 

year) 390 

Mental  hygiene 382 

Juvenile  delinquency 371 

Physiological  psychology 368 

Neurology:  diseases  of  nervous 

system 363 

Genetic  (dynamic)  psychology. .  353 

Genetics  (heredity) 344 

Child  hygiene 332 

Psychology  of  learning 329 

Sociology,  pathological 315 

Developmental  psychology 313 

Statistics,  advanced 307 

Social  psychology 300 

Higher  mental  processes 300 

Physiology 297 

Speech  defects 288 

Vocational  psychology 286 

Educational  psychology  (second 

year) 285 

Biology 277 

Sociology,  general 257 

Biometric  methods.  .  .  229 


Systematic  psychology 228 

Industrial  psychology  (first  year)  223 

Social  service  (methods) 222 

Practice  of  psychology 198 

Anthropology 196 

Clinical  physiology 196 

Class  experiments 188 

General  pathology 178 

Industrial  hygiene 168 

Animal  psychology 162 

Zoology 148 

Education,  seminar 147 

Personnel  administration 145 

Industrial  psychology  (second 

year) 133 

History  of  psychology 127 

Educational  systems 120 

Embryology 112 

Psychological  ethics 106 

Economics 92 

Business  administration  (first 

year) 86 

Physiological  chemistry 77 

Advertising  and  selling 65 

Bacteriology 65 

Business  administration  (second 

year) 50 

Business  ethics 23 

Epistemology 3 


Subjects  of  medical  bearing  rank  somewhat  conspicuously 
in  this  classification.  A  graduate  course  in  neuropsychiatry 
might  make  out  its  curriculum  from  the  ten  subjects  heading 
the  above  list.  The  topics  that  psychologists  regard  as  most 
important  are  pretty  much  those  that  medicine  would  under- 
take to  provide.  Some  of  them,  indeed,  depend  on  medical 
resources  and  cannot  be  had  without  medical  cooperation. 

The  main  conclusions  that  seem  to  emerge  are  that  psycho- 
metrics  is  the  task  of  technical  experts  who  often  are  not  and 
seldom  need  to  be  psychologists  in  the  broad  sense  that  ought 
to  attach  to  the  term.  It  is  doubtful  if  the  problems  of 
clinical  or  pathological  psychology  are  such  as  to  support  an 
important  professional  group  independently  of  medical  foun- 
dation. Medical  discipline  gives  the  best  background,  and  an 
all  but  requisite  type  of  background,  for  inquiries  involving 
the  major  affective  life  of  individuals.  There  is  no  funda- 


12          THE  STATUS  OF  "CLINICAL"  PSYCHOLOGY 

mental  conflict  between  psychology  and  medicine;  it  arises 
among  physicians,  on  the  one  hand,  and  psychologists  who 
are  masters  of  certain  medical  techniques  and  occupied  with 
certain  medical  problems  that  medicine  has  not  assimilated. 
Medicine  should  assume  greater  responsibility  for  them,  when 
the  conflict  will  disappear.  Meanwhile  the  administrative  duty 
of  psychology  is  to  develop  progressively  higher  standards  in 
training  and  accomplishment  and,  within  those  limits  where 
reasonably  accurate  judgment  is  possible,  means  of  attesting 
those  who  meet  these  standards.  That  this  can  and  should  be 
done  on  the  psychometric  level  seems  clear.  On  the  level  of 
the  independent  consultant,  one  must  distinguish  carefully 
between  measures  that  further  the  services  of  psychology  to 
society  and  those  that  seem  primarily  for  the  interest  of  a 
professional  group.  The  latter  policy  would  certainly  be 
without  value,  and  might  be  disastrous,  to  the  standing  of  the 
profession  as  a  whole. 


